Tibial plateau fracture

Background

• ACL and MCL injuries associated with lateral plateau fracture
• PCL and LCL associated with medial plateau fracture
• Compartment syndrome may occur
• Segond Fracture
  • Avulsion fracture of margin of lateral tibial plateau just below joint line
  • Associated with tear of ACL and meniscal ligaments

Clinical Features

• Occurs via axial load that drives femoral condyle into tibia

Differential Diagnosis

Knee diagnoses

Acute Injury

• Knee fractures
• Patella fracture
• Tibial plateau fracture
• Knee dislocation
• Patella dislocation
• Segond fracture
• Meniscus and ligament knee injuries
• Patellar Tendinitis (Jumper's knee)
• Patellar tendon rupture
• Quadriceps tendon rupture

Nontraumatic/Subacute

• Septic Joint
• Gout
• Popliteal cyst (Baker's)
• Prepatellar bursitis (nonseptic)
• Septic bursitis
• Pes anserine bursitis
• Patellofemoral syndrome (Runner's Knee)
• Patellar Tendinitis (Jumper's knee)
• Osgood-Schlatter disease
• Arthritis

Distal Leg Fractures

• Tibial plateau fracture
• Tibial shaft fracture
• Pilon fracture
• Maisonneuve fracture
• Tibia fracture (peds)
• Ankle fracture
  • Ankle fracture (peds)
    • Tillaux fracture
• Foot and toe fractures

Evaluation

Schatzker Classification of Tibial Plateau Fractures

Imaging

• AP, lateral, oblique views (internal for lateral plateau, external for medial plateau). Tunnel view may also be helpful.
  • AP - line drawn at lateral margin of femur should not have >5mm of tibia beyond it
• CT or MRI should be considered if plain film negative but high clinical suspicion based on mechanism or inability to bear weight

Schatzker Classification

• Schatzker I Lateral split
• Schatzker II Split with depression
• Schatzker III Pure lateral depression
• Schatzker IV Pure medial depression
• Schatzker V Bicondylar
• Schatzker VI Split extends to metadiaphysis

Management

• Knee immobilizer with non-weightbearing and ortho referral in 2-7d
• Emergent surgical management if open or if neurovascular compromise

Disposition

• Indications for referral within 48hr:
  • Significant displacement or depression
  • Suspected or documented ligamentous injury
• Indications for surgery
  • Articular stepoff > 3mm
  • Condylar widening > 5mm
  • Varus/valgus instability
  • All medial plateau fractures
  • All bicondylar fractures

See Also

• Fractures (Main)
• Knee (Main)

References

Authors

Ross Donaldson, Jay, Michael Holtz, Daniel Ostermayer, Neil Young